[Summary] In recent years , ultrasound guidance has been widely used in local anesthesia , particularly in peripheral nerve blockage .Ultrasound guided neuraxial blockage is also making progress .Previous studies have shown that pre-puncture ultrasound scanning could provide useful information on the correct intervertebral interspace , the midline of the spine , the optimal puncture point , the appropriate angle for needle insertion , and the distance from skin to the spinal canal .In this review, the ultrasonographic techniques and image analysis , as well as its clinical use , including pre-puncture scanning and real-time guidance for spinal and epidural anesthesia , were summarized .

SUMMARY A patient with previous L3 -4 posterior lumbar interbody fusion,pedicle screws instrumen-tation and L3 -4 decompression,was scheduled for left total hip arthroplasty.Two years ago,due to poor landmarks palpation,the patient experienced a failed lumbar puncture after multiple attempts before her-niorrhaphy.His plain radiography showed bilateral partial laminectomy at L3 -4 level,and between L3 and L4,two posterior pedicle screws connected by metal rods on both sides.This time,we used ultra-sound to locate L4 -5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture.According to this information,L4 -5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid,15 mg hyperbaric bupivicaine was injected into intrathecal space.An epidural catheter was then inserted into the epidural space.The sensory block level was fixed at T10 to S within 10 minutes.Intraoperatively,the patient received 10 mL 2% (mass fraction)lido-caine through the epidural catheter in total.The surgery was uneventful.No neurologic complication was observed after the surgery.This case report demonstrates that ultRASound imaging can provide useful in-formation for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Objective To investigate the effect of total quality management of foreign surgical instruments in nosocomial infection control in the sterilization and supply center. Methods The effect before and after the application of total quality management for foreign surgical instruments in the control of nosocomial infection in the sterilization and supply center was comparatively analyzed. Results The results showed that after the application of total quality management for foreign surgical instruments,the onetime passing rate of sterilization and limits of microbial detection of surgical instruments increased significantly compared with that before application.The passing rate after application was significantly higher than before.The difference was significant.The implementation rate of planed surgery depending on foreign surgical instruments was 98.3％,the rate was 92.4％ before application.There was a significant difference before and after application,the nosocomial infection rate after surgery depending on foreign surgical instruments was 0.88％,before the application was 6.50％,there was a significant difference before and after application. Conclusions Application of total quality management of foreign surgical instruments can significantly improve the efficiency of the use of foreign equipment and working efficiency of the operation room,reduce costs and the incidence of nosocomial infection significantly.It should be applied in the management of foreign surgical instruments in the sterilization and supply center.

Objective To understand the correct sexual health knowledge and source of sexual information among college students in Kunming, and provide the practical suggestions for students' sexual education. Methods A self-administered questionnaire survey was conducted among 950 students chosen from 5 universities in Kunming by cluster multistage sampling. Results The college students' health knowledge accuracy has certain significant differences between men and women, living urban and rural, inside and outside the province, and the Han and other nationalities. The most conversation partner discussing sex for the first time is their companion. Students get sex knowledge most in junior high school, and the school is the most important way to get these knowledge. Conclusion Sexual health knowledge education should be balanced between boys and girls, rural area students and minority students' knowledge of sexual health should be strengthened, and make them have a correct understanding onsex. In addition, strengthen the familysex knowledgeis also important.

Objective To study the Mediating effect of insecurity between childhood abuse and emotional distress of medical students,and to provide basis to intervene their mental disorder.Methods Through stratified sampling,262 medical students in Jiangsu were investigated by the Personal Report of Childhood Abuse( PRCA),Self-Rating Feeling of Insecurity Scale( SRFIS),Beck Depression Inventory( BDI ),Self-rating Anxiety Scale(SAS)and Suicide Ideation Scale(SIS).A path analysis was applied by Analysis of Moment Structures(AMOS) version 7.0.Results The path analysis showed that childhood abuse was directly related to insecurity of medical students ( β =0.538,P ＜0.01 ),and was directly related to emotional distress ( β =0.435,P ＜ 0.01 ).Insecurity were directly related to emotional distress of medical students ( β =0.342,P ＜ 0.05 ).Insecurity mediated partly the relationship between childhood abuse and emotional distress of medical students.The model fit indexes were X2/df =1.365 ＜ 3.000,P =O.082 ＞ 0.05,RMSEA =0.037 ＜ 0.050,GFI =0.971,AGFI =0.940,NFI =0.943,RFI =0.902,IFI =0.984,TLI =0.972,CFI =0.984.Conclusion Insecurity as mediated variable mediates the relationship between childhood abuse and emotional distress of medical students.

AIM: To investigate the effects of EPA and DHA on oxidative stress of lipopolysaccharide-stimulated rat mesangial cells. METHODS: The glomerular mesangial cells (GMCs) were stimulated by lipopolysaccharide (LPS) and incubated with EPA (10 μmol/L or 100 μmol/L) and DHA (10 μmol/L or 100 μmol/L) for 24 h, 48 h and 72 h. The activity of SOD, GSH-Px and the level of MDA was measured. The protein and mRNA expressions of MCP-1 and TGF-β_1 were detected by immunocytochemistry and real-time PCR method, respectively. RESULTS: The activities of SOD and GSH-Px were decreased and the concentration of MDA was increased when stimulated with LPS. EPA and DHA increased the activities of SOD and GSH-Px and decreased the concentration of MDA significantly. Meanwhile, the protein and mRNA expressions of MCP-1 and TGF-β_1 stimulated by LPS were decreased. DHA was more effective than EPA at the same concentration. CONCLUSION: EPA and DHA enhance the activities of antioxidant enzymes, decrease the concentration of MDA and inhibit the expression of TGF-β_1 and MCP-1, suggesting that the protective effect of EPA and DHA on kidney is related to the antioxidation and the inhibition of TGF-β_1 and MCP-1 expression.

Objective To summarize clinical diagnosis and microsurgical treatment method of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Methods Thirty-seven cases of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia treated by microneurosurgery procedure were analyzed retrospectively.Results Complete resection was achieved in 31 cases,and subtotal was achieved in 6 cases,with no operative mortality.Postoperatively,the symptom of trigeminal neuralgia disappeared in 28 cases,was eased obviously in 6 cases,and was eased in 3 cases.The symptom of dizziness in all 6 cases vanished,and hearing in 3 cases was improved.Three cases appeared cerebrospinal fluid leakage,and 4 cases appeared oral herpes.Symptom in 1 case aggravated after 6 months,and oral medicine was ineffective.The pain symptom disappeared after reoperation.Conclusions The suboccipital retrosigmoid approach microneurosurgery is the principal treatment method for cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Microsurgical technique combined with surgical skill is the guarantee for increasing total removal rate of tumors and decreasing complications.

Objective To summarize surgical strategies and skills against aneurysms of posterior circulation .Methods Twenty-one cases of posterior circulation aneurysms who had undergone microsurgery between March 2008 and March 2013 were analyzed retrospectively .Two of these cases had their basilar artery aneurysms clipped via the pterion approach and five through the subtemporal approach .Five posterior cerebral artery aneurysms were clipped via the subtemporal approach , two anterior inferior cerebellar artery aneurysms were clipped via the retrosigmoid approach , three posterior inferior cerebel-lar artery aneurysms were clipped through the far lateral approach , and two vertebral artery aneurysms were clipped similar-ly approach.Results All the aneurysms were clipped successfully .According to Glasgow Outcome Scale (GOS), the cura-tive effect was poor in 3 cases(GOS 2-3 points), good in 16 cases(GOS 4-5 points) and 2 patients died(GOS 1 point). Conclusion Aneurysms of posterior circulation can be treated through microsurgery .Proper surgical strategies , operative ap-proach and delicate surgical skills are critical to the success of surgeries and curative effects .

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cyclin D1 ; metabolism ; Female ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Aged ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Mouth Mucosa ; chemistry ; metabolism ; pathology ; Mouth Neoplasms ; metabolism ; pathology ; Prognosis

BACKGROUND: Pharmacological researches demonstrate that Chinese crude drugs of invigorating the kidney contain flavonoids such as prepared rhizome of rehmannia and kudzuvine root, they possess phytoestrogenic effect, among them, isoflavone acts as a regulator of estrogen receptor.OBJECTIVE: To approach the effects of self-planned Bushen Huoxue Fang (BSHXF) on the serum estradiol and estrogen receptor α mRNA expression in pituitary gland in rats with collagen-induced arthritis. DESIGN, TIME AND SETTING: Randomized grouping controlled animal experiment was performed in the central laboratory of Bethune Intemational Peace Hospital of Chinese PLA between May 2006 and May 2008. MATERIALS: Sixty female and healthy Wistar rats were randomly divided into sham operated group (n=10) and operation group (n=50). Operation group was reproduced collagen-induced arthritis model at 2 weeks following ovariectomy. The rats of arthritic index ≥ 5 were assigned into model group, BSHXF group, methotrexate (MTX) group, and MTX + BSHXF group, each group included 10 rats. The Chinese crude drugs were bought from LERENTANG drugstore in Shijiazhuang, including rhizoma drynariae, safflower, prepared rhizome of rehmannia, Herba Epimedii, danshen root, kudzuvine root and so on. After routine decoction, centrifugalization, rogue and condensing 1.3 kg/L decoction, the solution was sealed up, divided pack and reserved at 4℃.METHODS: Sham operated group and model group were intragastrically administered with normal saline 2 mL per day; BSHXF group with BSHXF decoction 2 mL per day; MTX group with MTX 2.6 mg/kg (2 mL) once a week, and normal saline 2 mL per day at other time points; MTX + BSHXF group with MTX 2.6 mg/kg (2 mL) once a week and BSHXF juice 2 mL per day. Each group was given 6 weeks.MAIN OUTCOME MEASURES: After blooding by abdominalis aorta, magnetic-split enzyme linked immunosorbent assay was applied to detect the level of serum estradiol. Reverse transcription-polymerase chain reaction detected the expression of estrogen receptor a mRNA in rat pituitary gland.RESULTS: Compared with model group, the expression of estrogen receptor a mRNA in pituitary gland increased in the MTX group, but there was not statistically significant. BSHXF + MTX group showed a significantly increased expression (P < 0.01). The expression of estrogen receptor α mRNA in BSHXF group was higher than MTX group, but lower than BSHXF + MTX group (P < 0.05). No significant difference existed between BSHXF group, BSHXF + MTX group and sham operation group. Compared with sham operation group, there were statistically significant decrease of estradiol in the model group. Compared with model group, the estradiol levels were shown to increase in three treatment groups. Among them, MTX group had slightly slower level with no significant difference (P > 0.05), while BSHXF + MTX group had the most obvious increase, which was close to normal level (P < 0.01). There was a significantly positive correlation between estradiol and the expression of estrogen receptor o mRNA (r=0.483, P < 0.05).CONCLUSION: Serf-planned BSHXF possessing oestrogenic hormonelike role can elevate the level of serum estradiol and upregulate the expression of estrogen receptor a mRNA in pituitary gland.